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Obama Poised to Sign Health Reform Bill

March 22, 2010 at 12:00 AM EST
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The House's Sunday night vote on health care sets the stage for the Senate and President Barack Obama to complete the passage of the historic reforms. Jeffrey Brown talks to Susan Dentzer, editor-in-chief of Health Affairs, about what the legislation will mean for the American public.
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JEFFREY BROWN: Democrats celebrated today after the House passed health care reform late last night. The focus now shifts back to the Senate for a final round in this long political fight.

“NewsHour” congressional correspondent Kwame Holman begins our coverage.

KWAME HOLMAN: Washington woke today to rainy skies, but the mood was sunny among House Democrats who pushed for the landmark health care overhaul.

REP. PATRICK KENNEDY, D-R.I.: I think people will be more feeling confident of the fact that they have accountability in who is making their medical decisions. And it’s going to be their doctors. It’s going to be a review board. And, finally, there’s going to be protections against people being discriminated against because of preexisting condition and chronic illness.

KWAME HOLMAN: But, on the other side of the aisle, Republicans bemoaned the outcome in the House.

REP. TOM PRICE, R-Ga.: Madam Speaker, it’s raining here in Washington today. It’s raining because our founders are weeping. Our founders are weeping over the incredible vote taken yesterday that was an affront to federalism, an affront to individual liberty, and an affront to freedom.

MEN AND WOMEN: Yes, we can! Yes, we can!

KWAME HOLMAN: The climactic moment came late Sunday, after more than a year of debate. By 219-212, three more than needed, the House approved the bill that cleared the Senate last December. All 178 House Republicans voted against it, as did 34 Democrats.

Ultimately, final passage of the Senate bill was secured when President Obama reached an agreement with anti-abortion Democrats. The president agreed to sign an executive order reaffirming that no federal money provided by the bill would go to fund abortion.

Shortly before midnight, the president hailed the historic victory with Vice President Biden at his side.

U.S. PRESIDENT BARACK OBAMA: Good evening, everybody.

We proved that this government — a government of the people and by the people — still works for the people. I want to thank every member of Congress who stood up tonight with courage and conviction to make health care reform a reality. And I know this wasn’t an easy vote for a lot of people. But it was the right vote.

KWAME HOLMAN: At the Capitol today, Democratic leaders held a ceremony to mark the sending of the health care overhaul to the White House.

KWAME HOLMAN: The bill aims to extend health care coverage to 32 million uninsured Americans beginning in 2014. Almost everyone will have to be insured, or else pay a fine.

The new law also will set new regulations on insurers and impose new Medicare taxes on better-off Americans to offset lost revenue. But parts of the measure will change almost immediately if the Senate adopts fixes that also passed the House.

Majority Leader Harry Reid:

SEN. HARRY REID, D-Nev., majority leader: A strategy of delay, myths and fear might slow progress, but it cannot stop it. I hope that, this week, when we take up the final revisions of what will soon be long-overdue law, our Republican friends will finally act in the interest of their constituents, and not just the interest of the insurance industry or their political party.

KWAME HOLMAN: The House changes add more Medicaid funding and close a gap in Medicare’s drug coverage, raising the overall cost to $940 billion over 10 years.

But Senator John McCain and other Republicans vowed to try to repeal the health care law next year.

SEN. JOHN MCCAIN, R-Ariz.: With all this euphoria that’s going on, this inside-the-beltway champagne-toasting and all that, outside the beltway, the American people are very angry. And they don’t like it. And they’re going to — and we’re going to try to repeal this. And we are going to have a very spirited campaign coming up between now and November. And there will be a very heavy price to pay for it.

KWAME HOLMAN: The anger McCain mentioned had boiled over at times this weekend. At one point, someone shouted “baby killer” as anti-abortion Democrat Bart Stupak explained his yes vote. Texas Republican Randy Neugebauer said today he was the one who yelled, and he apologized.

PROTESTERS: Kill the bill!

KWAME HOLMAN: Outside the Capitol, hundreds of protesters chanted “Kill the bill” at passing Democrats. Congressman John Lewis was subjected to racial slurs, while another demonstrator spat on Representative Emanuel Cleaver. And, inside the Capitol, a protester yelled an anti-gay remark at openly gay Congressman Barney Frank of Massachusetts.

Officials from at least 11 states plan to challenge the health care legislation in court, saying it infringes on state sovereignty.

JEFFREY BROWN: So, after the long, loud, complicated debate over health care, what does it all mean for Americans, those currently uninsured and those covered by a private or other plan?

We’re going to break it down over the next days, beginning tonight with the impact on the private insurance market, where some 200 million Americans now have coverage.

Here for that is Susan Dentzer editor-in-chief of the journal “Health Affairs” and a regular analyst for the “NewsHour.”

Welcome back.

SUSAN DENTZER: Great to be here, Jeff.

JEFFREY BROWN: Let’s start broadly with that new mandate that Kwame just talked about, mandate for individuals and employers. Most Americans would be required to obtain health insurance. Most large employers would have to cover their employees. This means an expanded private market.

SUSAN DENTZER: Exactly.

The thrust of these measures are really to shore up the existing private market, as we said, 200 million in private insurance, about 175 million in employer-provided insurance.

So, for example, if you work for a company that employs 200 or more people, that company would have to automatically sign you up every year in its insurance plan. If you work for a company that has 50 or more employees, there are some provisions that put real strong pressure on those companies to provide coverage for their workers, or else potentially pay penalties.

So, then, of course, there’s the individual mandate, which would go into effect in 2014. That applies to everybody except people who can claim that they should be exempt because they can’t afford it or because their religious beliefs, Christian scientists — you shouldn’t have to buy health insurance — you can get out of the mandate.

Otherwise, you will have to pay a penalty. That penalty starts low, at $95 in 2014, but it phases up over the next few years to about $695, or 2.5 percent of taxable income.

JEFFREY BROWN: If you work for a small company…

SUSAN DENTZER: Well, that — the mandate…

JEFFREY BROWN: … there’s some special provisions there.

SUSAN DENTZER: The individual mandate will apply to everybody.

JEFFREY BROWN: Right.

SUSAN DENTZER: That applies to everybody. So…

JEFFREY BROWN: But those companies get a little help.

SUSAN DENTZER: If you’re employer — if you’re getting employer-based coverage now or you’re being offered it, and you’re not taking it up, you’re going to want to rethink that, because, otherwise, you would have to pay the — the individual mandate-related penalty.

Then, if you’re working for a small business, small businesses get tax credits. And those go into effect immediately to help small businesses provide coverage for their workers. And those tax credits will continue over time as well.

JEFFREY BROWN: All right, now let’s move to some of the insurance industry reforms that are going affect a lot of people here with insurance.

We have highlighted some of the — some of the key ones here. Insurance companies won’t be able to reject individuals based on health conditions or past history, set annual or lifetime coverage limits, or deny coverage for preexisting conditions.

Walk us through some of that.

SUSAN DENTZER: That’s right. Essentially, what these — these are measures designed to put into the so-called individual insurance market — that’s where people are buying it on their own, not getting it through an employer — bring those same protections that apply to other parts of the market to that individual market, so that no more preexisting condition restrictions, and on children in particular.

And that goes into effect almost immediately. Most of these insurance provisions go into effect within six months after the bill is enacted.

JEFFREY BROWN: So, let me say that again. The one on children goes into — this is for preexisting conditions.

SUSAN DENTZER: For preexisting conditions for children.

JEFFREY BROWN: Goes in immediately.

SUSAN DENTZER: Goes into effect immediately — no more preexisting condition restrictions on kids.

JEFFREY BROWN: And for everybody else?

SUSAN DENTZER: But, for everybody else, that will phase in — also phase in beginning this year, six months after enactment, no more cancellations of policies, so-called rescissions.

If you’re sick — you get an insurance policy, you’re sick, your insurance company calls up and says, I’m sorry, you didn’t tell us about X, Y or Z, we’re not covering you anymore, that goes away. That stops.

And then some other very important insurance market regulations, one in particular that’s designed to put pressure on insurance company profits and on their administrative expenses, and this would require insurers to pay out in claims 80 percent of the premium dollars that they take in for the individual insurance and small group insurance and 85 percent for this so-called large group market.

So, it’s a way, as I say, of basically putting pressure on insurers to pay out more money in claims and not pocket so much.

JEFFREY BROWN: And just for comparison’s sake, I mean, how does that compare to now?

SUSAN DENTZER: Well, for example, in the small group market and in the individual market, it’s not uncommon for insurers to pay out only 60 percent of the dollars they take in, in claims, and reserve that additional 40 percent for all the other things they do, medical underwriting, basically, rating people and figuring out what they should charge them, et cetera.

JEFFREY BROWN: Now, higher-income folks will be — will face some new taxes and some new fees?

SUSAN DENTZER: Yes, exactly.

And what — one of the big areas of controversy, of course, was the tax on high-cost health insurance plans.

JEFFREY BROWN: The Cadillac plans, so-called.

SUSAN DENTZER: The so-called Cadillac plans. That now wouldn’t kick in until 2018, so a few years to get used to it. And, basically, that’s a measure to try to force down health insurance prices overall.

JEFFREY BROWN: Now, speaking of that, I mean, one of the great unknowns — the great unknown, I guess, is impact for individuals on their premiums and the coverage that they will get, and, of course, the larger question of the impact on overall health care costs.

But would — for individuals, what are the question marks out there for their premiums looking ahead?

SUSAN DENTZER: Well — well, one key question is going to be, how do the new markets that will unfold shape up? For example, the states will all be charged with setting up health insurance exchanges. That is to say, they will have to — it’s almost like a health insurance food court. Each state will have to set one up for individuals to shop for insurance and for small businesses to shop for insurance.

Now, also within that construct, there are going to be rates — different rates set on how much premiums can vary depending on whether you’re older or younger, so that’s going to influence some insurance prices a bit. Benefits packages are going to be standardized. And, by and large, most of the benefits packages are going to be fairly generous.

So, we sort of throw all that into the great Cuisinart and say, where does it come out in terms of premiums? It’s very hard to say at this point. It’s quite possible that some people will be able to buy much more generous coverage than they have ever had to date. Some people will probably be paying more for coverage that’s pretty much like they have now. We will have to see how all of this plays out over time.

JEFFREY BROWN: All right, there’s a lot more here. We will leave it there for tonight. We will continue tomorrow with the new law’s impact on the uninsured, those on Medicare, and more.

For now Susan thanks a lot.

SUSAN DENTZER: Thanks, Jeff.